Key result
Combined Purkinje ablation and substrate modification eliminates refractory incessant VF in 100% of cases.
Why the study?
Refractory incessant ventricular fibrillation in critically ill patients lacks effective rescue strategies beyond mechanical circulatory support.
Does combined Purkinje-targeted ablation and substrate modification restore sinus rhythm in critically ill patients with refractory incessant ventricular fibrillation?
Case Report (n=3)
Does combined Purkinje-targeted ablation and substrate modification restore sinus rhythm in critically ill patients with refractory incessant ventricular fibrillation?
Combined Purkinje-targeted ablation and substrate modification during ongoing VF may serve as a life-saving rescue strategy for patients with refractory incessant VF on mechanical circulatory support.
We report a case series of 3 critically ill patients with refractory incessant ventricular fibrillation (VF) who underwent catheter ablation using high-density mapping of the Purkinje system during ongoing VF, combined with targeted Purkinje denetworking and myocardial substrate modification. All patients were supported with advanced mechanical circulatory support, including venoarterial extracorporeal membrane oxygenation or venoarterial extracorporeal membrane oxygenation with Impella support, and procedures were guided by electroanatomic mapping with multimodality imaging integration. Purkinje potentials and abnormal electrograms within infarcted and border-zone myocardium were targeted, resulting in restoration and maintenance of sinus rhythm with no inducible ventricular arrhythmias after ablation. These findings suggest that, in carefully selected patients, combined Purkinje-targeted ablation and substrate modification may provide a life-saving rescue strategy for otherwise refractory incessant VF.
No takes yet. Share an insight, caveat, or question.
Chahal et al. (2026) conducted a case report in Refractory incessant ventricular fibrillation (n=3). Catheter ablation using high-density mapping of the Purkinje system, targeted Purkinje denetworking, and myocardial substrate modification was evaluated on Restoration and maintenance of sinus rhythm with no inducible ventricular arrhythmias after ablation. Combined Purkinje-targeted ablation and substrate modification successfully restored and maintained sinus rhythm without inducible arrhythmias in 100% (3/3) of patients with refractory incessant VF.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: